Provider Demographics
NPI:1609086933
Name:OBGYN SPECIALTY GROUP, PC
Entity Type:Organization
Organization Name:OBGYN SPECIALTY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:313-345-3144
Mailing Address - Street 1:19830 JAMES COUZENS FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1938
Mailing Address - Country:US
Mailing Address - Phone:313-345-3144
Mailing Address - Fax:313-345-3458
Practice Address - Street 1:19830 JAMES COUZENS FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1938
Practice Address - Country:US
Practice Address - Phone:313-345-3144
Practice Address - Fax:313-345-3458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAA033474207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI16-0H21245-0OtherBCBSM
MI2994435-10Medicaid
MI16-0H21245-0OtherBCBSM
MIB44676Medicare UPIN